Individual
DR. EDWARD ROBERT JACKSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3334 CAPITAL MEDICAL BLVD #400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Mailing address
3334 CAPITAL MEDICAL BLVD #400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
063075
GA
207X00000X
Orthopaedic Surgery Physician
BP10016960
TX
207X00000X
Orthopaedic Surgery Physician
ME107624
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
63075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002458400
—
FL
01
—
003214650
UNITED HEALTH CARE
FL
01
—
250872
UNIVERSAL HEALTHCARE
FL
05
—
503370302B
—
GA
01
—
P00903177
RR MEDICARE
GA
Enumeration date
03/27/2009
Last updated
09/13/2022
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